Role of Private Sector in medical care during disaster Dr. S. Kumar Principal & Dean

1. M.S. Ramaiah Medical College & Hospitals Role of Private Sector in medical care during disaster Dr. S. Kumar Principal & Dean

2. Goal • The goal of care during a Mass Casualty Incident is to provide the greatest amount of good for the greatest number of potentially survivable victims. • Make the best use of personnel, equipment and facility resources.

3. Ideal - What resources (inputs) are required? • 50-60 beds dedicated to disaster services. • Target 12,000 beds – fully equipped, with qualified staff & necessary infrastructure. • Cost : Approx. Rs.3,600 crores.

4. Logical Framework Analysis (LFA ) • What the project is due to achieve ? • What are the planned activities to achieve its outputs & purpose ? • What resources (inputs) are required? • What are the hurdles / problems perceived ? • Project assessment – progress, successes.

5. What are the planned activities to achieve its outputs & purpose ? • Create awareness in the Community. • To empower the community to supplement the efforts of the Governmental agencies. • To train capable members from the community in BTLS, CPR, safe disposal of hazardous & biological wastes. • To enhance confidence levels of the community in casualty management.

7. What the project is due to achieve ? • Cost effective, judicious use of available reserve capabilities of the private sector. • Avoid unwarranted burdening of the exchequer ( estimated at Rs.3600 crores ). • Addresses the problems perceived in establishing disaster beds by the government. • Manpower mobilization, • Stock-pile rotation. • Non disaster time use/misuse of the facility created.

8. What the project is due to achieve ? • Convert our ( private sector ) ability into responsibility by systematic training. • To have a system in place across the country by which we can respond with grace under times of stress.

9. What are the planned activities to achieve its outputs & purpose ? • Capacity identification of private healthcare providers. • Networking of private sector. • Create a data base of the resources & skilled manpower available. • Periodic training & capacity development. • Establish Consortium of Disaster Care. • Role assignment & mobilize commitment of all.

10. Health care Scenario • Government effort – • Hospitals under H & FW. • Hospitals attached to Government Medical Colleges. • Private Sector – • Corporate Hospitals & larger Nursing Homes. • Hospitals attached to Private Medical Colleges.

11. Government Hospitals • Total number of – • Hospitals : 7008 • Beds : 4,69,672 • Beds per lakh of population : 89 • Budget out Lay : Rs. 83/- ( Plan out lay : 55,344 crores ) • Medical Colleges : 124. • Beds : > 1,10,000. • Reserve capacity : ?

12. Private Health Care • Major hospitals : • Number – 15,367. • Beds – 502,150. • Reserve capacity - ? • Medical Colleges : • Number – 147 • Beds – 95,000. • Reserve capacity – 32,000 beds.( 30% ).

13. Aim & Assumptions • Aim • To ensure timely response and coordinated immediate care during a mass casualty event. • Assumptions: • Trained medical personnel involved in emergency management are limited in spite of immediately available resources. • Resources utilization will become appropriate only with available trained personnel. • Hence the need to net work and raise awareness.

14. Aim of Private Initiative • The Mass Casualty Incident (MCI) is managed through the Incident Command System (ICS) or Incident Management System (IMS). • The ICS/IMS is a sequence of response to any MCI on scene consisting of: Scene Assessment, Alerting Process, Field Organization, Evacuation, Triage, Stabilization, Transport and definitive care at the receiving Hospitals.

15. Target • In the event of disaster the receiving hospitals who are alerted will need to provide ambulance services and personnel as available for transferring of patients from the incident site to the networking hospitals under the ICS according to the hospital disaster plan. • The receiving hospitals will in principal establish a hospital disaster management policy – which will be communicated to all concerned.

16. What are the planned activities to achieve its outputs & purpose ? • Deliver disaster management concept and training through medical students – as part of Community Medicine field postings. • By this we will be utilising the services of the vast human resource ( 160 thousand students ) in the Medical colleges. • NEED towards this: to modify the curriculum to deliver this need to the nation.

17. Goal is to distinguish between: • Victims needing life-saving treatment that can only be provided in a hospital setting. • Victims needing life-saving treatment initially available on scene. • Victims with moderate non-life-threatening injuries, at risk for delayed complications. • Victims with minor injuries.

18. Thus emergency response in a MCI is a dynamic process. • Needs expedient training of emergency personnel in emergencies. It has been field-proven in mass casualty incident to follow a structured program. • Program BTLS / ITLS – for all eligible people.

19. New Initiatives of Private Sector • Health City Model • 5000 beds at all state capitals • 4 of the project – Kolkatta, Ahmedabad, Jaipur and Bangalore – ready by 2010 • 75% of these beds dedicated for below poverty line citizens. • Facility to receive disaster victims including piped oxygen at “car park”

20. Dr Shetty, Shaw plan Health Cities in all State capitals • DECCAN HERALD NEWS SERVICE, BANGALORE : • Promising a chain of 5,000-bed “Healthcities” in every state capital, Narayana Hrudayala and Biocon CMD Kiran Mazumdar Shaw on Wednesday announced the launch of the project to supplement the country’s public healthcare system. • Ms Shaw and the Hrudayala Chairman Dr Devi Shetty told reporters that 75 per cent of the beds will be earmarked for the working and poor. AIG Investments and JP Morgan have joined in as private equity investors for the project. • At the Narayana Health City in Bangalore, a 1000 bed ‘Mazumdar Shaw Cancer Centre’ is scheduled to be commissioned in the next few months. This will be scaled up to a 5,000-bed health city addressing the needs of 15,000 outpatients a day. This model will be replicated in Kolkatta and Jaipur. • Dr Shetty said various state governments had allotted land for the project at subsidised rates--Jaipur (40 acres), Ahmedabad (37 acres), Jameshedpur (where they will be acquiring a trust).

22. New Initiatives of Private Sector • Devi Shetty & Kiran Mujumdar Shah. • Sankara Nethralaya. • Realty Group. • AMRL group. • Manipal group. • Ambuja Realty – Neotia Healthciti. • Mission of Mercy Hospital.

23. Article in Economic Times

24. Problems perceived. • Cost : Rs.3,600 crores. • ? Support from Government – reimburse the cost of participation : cost of consumables. • Problems perceived. • Manpower / human resource. • Stock-pile rotation

25. Public Private Partnership offer Must become a reality in the true spirit. • NEED : A MOU with private stake holders. • Costing Vs. Billing. • Advantages • Cost effective model. • Address the problems perceived.

26. Fund mobilisation • For community awareness programs through participation from philanthropic institutions / Industry / NGOs. • Mobilising Insurance coverage for “high risk” areas through PPP model.

27. Other needed efforts : • Training people to allow the head to rule and not the heart at the times of disaster – need is a “Harmony of the Heart & Head”. • Minimize / Abolish panic created by rumors • Introduce the concept of “ICE” / “NOK” in cell phone users. • Establish distinct “command lines” for communication.

28. Hope ! • Healthcare providers of this country need to reprogram their minds and start the untried. • The real voyage of any discovery consists not in seeing new land scapes, but in having new vision.

29. Contact details Dr. S. Kumar, Principal & Dean, M.S. Ramaiah Medical College & HospitalsMSR Nagar, MSRIT Post, Bangalore – 560 054Tel: 080-2360 1852 / 2360 5190 / 2360 1742 Fax: 080-23606213 Email : drskumar16@hotmail.com msr_medical@dataone.in Web: http://www.msrmc.ac.in

31. Thank you